Sinusitis and its management

doi:10.1136/bmj.39092.679722.BE

BMJ 2007;334:358-361 (17 February), doi:10.1136/bmj.39092.679722.BE

Clinical Review

Sinusitis and its management

Kim W Ah-See, consultant ENT surgeon, Andrew S Evans, specialist registrar in ENT

Department of Otolaryngology, Head, and Neck Surgery, Aberdeen Royal Infirmary, Aberdeen AB25 2ZN

kim.ah-see@nhs.net

The first 150 words of the full text of this article appear below.

Sinusitis is one of the most common diagnoses in primary care.It causes substantial morbidity, often resulting in time offwork, and is one of the commonest reasons why a general practitionerwill prescribe antibiotics.¹

Summary points

Rhinosinusitis is a common primary care condition

Mostcases of acute rhinosinusitis resolve with symptomatic treatmentwith analgesics

Chronic rhinosinusitis may, however, requirereferral to an ear, nose, and throat specialist for possibleendoscopic sinus surgery if medical management fails

Patientswith acute facial pain or headache but no other nasal symptomsare highly unlikely to have rhinosinusitis

Urgent referralis required if complications of rhinosinusitis are suspected—suchas orbital sepsis or intracranial sepsis

Sources and selection criteria

We searched Medline for recent papers (1996-2006) using "sinusitis","rhinosinusitis", "acute", "chronic", "diagnosis", and "management"as keywords. We also searched the Cochrane Database of systematicreviews using the keywords "sinusitis" and "rhinosinusitis".In addition, we used a personal archive of references . . . [Full text of this article]

Causes of sinusitis

Box 1: Common causes of rhinosinusitis
Box 2: Rarer causes of rhinosinusitis

Clinical diagnosis and pathophysiology

Box 3: Symptoms of rhinosinusitis
Box 4: Timescale for rhinosinusitis
Box 5: Bacteriology of acute and chronic rhinosinusitis
Acuterhinosinusitis
Chronic rhinosinusitis

Are other investigations required?

What is the influence of allergy in rhinosinusitis?

How is sinusitis treated medically?

Acute rhinosinusitis
Chronic rhinosinusitis
Box 6: Sinister features that should prompt referral to specialist

What is the role of surgery for rhinosinusitis?

What are the complications of rhinosinusitis?

Additional educational resources
Resources for healthcareprofessionals
Resources for patients

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